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A1:  Sepsis Poster -  Deb Scott
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A1: Sepsis Poster - Deb Scott

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  • 1. Scottie’s Sepsis September: A Review
  • 2. Background• We had… • documented delays in recognition & treatment of sepsis contributing to patient harm • tried this once before and failed (2008)• We knew implementing the sepsis bundle was the right thing to do because… • early recognition and intervention leads to better patient outcomes • improvement bundles work • it is important for our patients, our agency and to PHSA (Included in the 11/12 Strategic Action Plan).
  • 3. Problem StatementLack of standardized recognition, communication of findingsand response to sepsis have lead to long lead-times fromrecognition to response and have caused patient harm
  • 4. Primary Objective & Key Measure• Primary objective: – To implement an internationally-recognized sepsis screening tool and treatment protocol.• Key measure: – Documented timely screening of appropriate patient population and where required, timeliness of medical intervention.
  • 5. Kaizen Strategy
  • 6. Kaizen StrategyAreas of Focus:
  • 7. Recognition PDSA Cycles• Problem: – No standard work• Idea: – Standardize screening process throughout the BCCH • When to screen • Who to screen • How to screen• PDSA cycles – 14 (& counting) – Testing of screening tool for value added • Relevance to patient population balanced with: – time to complete – frequency of use = time vs benefit – Readability – Standard work instructions within screening tool – Alignment of screening with existing processes/tools Recognize - Respond - Refer
  • 8. Aligned with ED Triage and Initial Assessment• Andon for screening on electronic patient tracking board (to be developed)• Combined sepsis screening tool with RN assess form (to be developed) Recognize - Respond - Refer
  • 9. Aligned EoPC with Sepsis Screen in Inpatient Areas Recognize - Respond - Refer
  • 10. Aligned with Fever & Neutropenia Guidelines • Bloodwork standardized • Inclusion of fever & neutropenia antibiotic protocol into sepsis bundle • Adaptation of screening tool to reflect oncology patient & referral process Recognize - Respond - Refer
  • 11. Aligned with PICU “Purple Sheet”• Highlight WBC trends as indicator for sepsis screening Recognize - Respond - Refer
  • 12. Result Recognize PDSA Cycles• Standard work for screening New Admission to Unit (Including who, when & how) Screen for Sepsis New Patients Existing Patients Monitor and Assess NO Increase in EoPC Score YES Screened Positive (+) for Acute Organ Dysfunction NO YES Screen for Sepsis Follow escalation of patient care protocol Recognize - Respond - Refer
  • 13. PDSA Cycles with Response • Problem: – No standard escalation process or response upon suspicion of sepsis. • Idea: – Standardize response process and treatment • PDSA – Aligned with EoPC process for monitoring and accessing supports Recognize - Respond - Refer
  • 14. PDSA Cycles with Response • PDSA (con’t) – “Suspected Sepsis” order set & Algorithm (Final testing) – Incorporated audit components (Order time, receipt time, delivery time) – “Critical Care Sepsis” order set & Algorithm Recognize - Respond - Refer
  • 15. PDSA Cycles with Refer• Problem: – No standard work for referring patients• Idea: – Aligned with EoPC process• PDSA: – Reinforcement of existing escalation processes. – Highlight supports and screening prompts with First Responders, CTU residents and PICU team Recognize - Respond - Refer
  • 16. Results of Kaizen Events X X DELAY INCONSISTENTPatient Condition Worsens X DELAY Recognition of deterioration by “someone” Assistance sought Management by most appropriate resources Relocation to appropriate care area if required X XX X INCONSISTENT DELAY Medical Intervention INCONSISTENT DELAY
  • 17. Follow On Six units developed detailed Action Plans. Some examples:• All areas: – Ongoing measurement – Update communication plan – Living PDSA cycle collectively (8 month timeframe) – Physician order sets have been approved and are available for use• ED: – Update documentation • Incorporate sepsis screening – Further defined measurement process – Implement Status Board andon• PICU: – Test critical care algorithm and order set• Oncology: – Updated Fever & Neutropenia order sets.
  • 18. Accomplishments• Recognize: – Screening tool as part of standard work – Highlighted usefulness of existing processes and tools in screening process – Strengthened existing processes/tools• Respond: – Initial resuscitation order set & algorithm redesigned & in use – Critical care order set & algorithm designed & are available for use• Refer: – Clarification with PICU re: role in screening
  • 19. Lessons Learned• Surprises – 75% of areas liked “it” – Value of standardization – Linkages between other processes – EoPC documentation patterns – Number of changes hitting staff at once• Highlighted for next time – Communication (more & targeted) – Assessment of organizational readiness (e.g., upcoming changes and resources available to be successful)
  • 20. Audit Plan• Question: Screening for sepsis at appropriate times• Question: Timeliness of response upon (+) screen
  • 21. References• Brierley J, Carcillo JA, Choong K et al. (2009). Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Critical Care Medicine. 37, 666-688.• Cruz AT et al. (2011). Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics; 127: 3 e758-766.• Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R et al. (2008). Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine. 36, 296-327.• Goldstein B, Giroir B, Randolph A. (2005). International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr. Critical Care Medicine. 6(1):2-8.
  • 22. Contact InformationDeb Scott RN BScNProfessional Practice LeaderBC Children’s Hospitaldscott6@cw.bc.ca604-875-3059Jamie LepardFacilitator, imPROVEProvincial Health Services Authorityjlepard@cw.bc.ca604-916-5795